Positive assertion and acceptance among persons with disabilities.

Positive Assertion and Acceptance Among Persons with Disabilities

Data were collected from several groups of persons with various disabilities to determine factors contributing to assertiveness and acceptance of disability. Type of disability was found to be a significant predictor for assertiveness and acceptance. Several contributing demographic factors are discussed based on their relevance to the variables studied. Populations which are in greatest need of assertion training and counseling for acceptance of their disabilities are identified.

One's perceptions of one's disability is a key to the rational acceptance of the fact of disability. In one of the classics in rehabilitation literature, Beatrice Wright (1960) stated, "A shameful fact cannot be accepted as long as it remains shameful". The healthy incorporation of the fact of disability into one's self concept gives the confidence to assert oneself as a self-governing adult (DeLoach & Greer, 1981). The positive acceptance of disabilities by persons with disabilities has traditionally been described as a crucial variable in the rehabilitation process because it enables individuals to accept the realities of their disabilities, reorder their values and priorities and continue productive lives (Dembo, Leviton & Wright, 1975; Wright, 1960). Acceptance of disability is perceived as a realization of the difficulty of disabling conditions, but, at the same time stresses the intrinsic value and ability of individuals (Thorenson & Kerr, 1978). Disability onset is traumatic and stressful and can affect personal adjustments and rehabilitations. Heinmann and Shontz (1984) point out that adaptation is an individual process which may parallel previously established coping styles and be influenced by environmental situations. The positive relationship between disability acceptance and self esteem found by Linkowski and Dunn (1974), Starr and Heiserman, (1977), Heinmann and Shontz (1984) and Patrick (1984) emphasizes the importance and practicality of a rehabilitation focus on disability acceptance. In addition to a focus on acceptance of disability, there has been increased emphasis on the importance of assertiveness in adjustment and rehabilitation. Assertive behavior may be perceived as interpersonal responses involving direct, honest and appropriate verbal and non-verbal expressions of thoughts, feelings and beliefs in ways that do not violate other persons' rights (Lange, & Jakubowski, 1976). Locus of control, self-confidence, personal adjustment, anxiety, appropriate expression of anger, and acceptance of disability appear to be related to assertiveness. Research by Percell, Berwick and Beigel (1974) indicates that as individuals become more assertive, manifest anxiety decreases, while self-confidence (Gay, Hollandsworth & Galassi, 1975), personal adjustment (Galassi & Galassi, 1974), appropriate expression of anger (Doyle & Briggio, 1981), and acceptance of disability (Morgan & Leung, 1980) increase.

Although individual's adjustment processes differ, many people experience to varying degrees feelings of denial, mourning, depression, and anger before reaching acceptance of their disabilities (Dembo et al., 1975). During these periods of adjustment some persons with disabilities may experience losses of self-confidence along with increased anger and anxiety. These problems may result in reactive or passive stances rather than proactive or assertive stances toward their disabilities and rehabilitation and therefore impede the adjustment process (Cull & Hardy, 1972; Siller, 1969). In addition persons with disabilities may need higher levels of assertion to facilitate their successful re-entry into competitive social and working environments. Vocational Rehabilitation clients have often been viewed as lacking social and self-presentation skills necessary for effective social and vocational performance (Craven, 1979; Farley & Hinman, 1987; Rusch & Mithang, 1980; Wright, 1980). The Comprehensive Needs Study of Individuals With The Most Severe Handicaps compiled by the Urban Institute (1975) and cited in Rogers, Thurer and Pelletier (1986) found that many persons with severe handicaps are socially isolated, have poor self-concepts, and have the majority of their social contacts with family members. In addition many of the severely disabled as well as less severely disabled have difficulty interviewing successfully, which is necessary for obtaining jobs and exhibiting the social skills helpful in maintaining jobs (Farley and Hinman, 1987). Gambrill, Florian and Splaver (1986) indicate the need for assertive training programs for those who can benefit, to enhance social skills and focus on specific skills in such areas as job seeking, family interactions, courting and development and maintenance of friendships.

The purpose of this study was to investigate the relationship between one's assertive behavior levels and acceptance of disability. The study also investigated differences in the degrees of assertive behavior and acceptance of disability among persons with disabilities based on age, gender, race, educational level, marital status, metropolitan or non-metropolitan residence, type of disability and length of time disabled.

The factors were based on the likelihood of usefulness in the provision of relevant services in the rehabilitation counseling process with disabled clients, and also increase efficiency by focusing on specific clients and areas in which these clients need assistance. Rehabilitation counselors may assess service needs based on the factors in this study.

Method

Sample

The sample for this study consisted of 160 disabled adults receiving rehabilitation counseling services from state vocational rehabilitation agencies. The subjects were divided into eight primary disability categories; cardiovascular, spinal cord injured, neurologic, orthopedic, visually impaired, hearing impaired, borderline and educably mentally retarded and substance abusers. Each participant was selected on a voluntary basis. Persons were selected for the sample until there were 20 persons in each of the eight primary disability categories.

Instruments

The three instruments that were used in this study are the Adult Self Expression Scale (ASES), (Gay, 1974), the scale of Acceptance of Disability (AD), (Linkowski, 1971) and a descriptive data form used to obtain demographic information about participants, (i.e., age, gender, race, education, marital status, metropolitan or non-metropolitan residence, type of disability, and length of time disabled.

The Adult Self-Expression Scale

The ASES is a 48-item, self report measure of assertiveness. The ASES uses a five-point Likert format (0-4); (0) "almost always," (1) "usually," (2) "sometimes," (3) "seldom," (4) "never or rarely." Scores for the ASES range from 0 to 192. The mean score is 115 with a standard deviation of approximately 20. ASES scores falling about 135 or higher are considered high and scores below 95 are considered low (Gay, 1974). The first of two dimensions of the ASES specifies interpersonal situations in which assertive behaviors might occur, such as interactions with family, friends authority figures, and the public in general. The second dimension specifies assertive behaviors that might occur in expressing personal opinions, refusing unreasonable requests, taking initiative in conversation, expressing positive or negative feelings, standing up for legitimate rights, and asking favors of others.

The reliability and validity of the ASES have been studied. A Pearson product moment correlation computed after two-week and five-week intervals produced reliability coefficients of .88 and .91 respectively. Internal consistency was determined by correlating the odd-even scores for 464 subjects. A Pearson product moment correlation resulted in a .79 reliability coefficient (Gay, 1974; Gay, Hollandsworth & Galassi, 1975).

Several validity studies have been conducted for the ASES (Gay, 1974; Hollandsworth, Galassi & Gay, 1977). Construct validity was established by correlating the total scores of individuals taking the ASES with their scores on the 24 scales of the Adjective Check List (ACL). The ASES was found to correlate positively and significantly (p [is less than] .001) with the Number of Adjectives Checked, and the Self-Confidence, Lability, Achievement, Dominance, Affiliation, Heterosexuality, Exhibition, Autonomy, Aggression and Change Scales. A negative correlation was found (p [is less than] .001) with ASES and the Succorance, Abasement, and Deference Scales of the ACL.

The method of contrasting groups was used to establish construct validity for the ASES. Thirty-two clients seeking personal adjustment counseling scored significantly (p [is less than] .05) lower (x = 101.81) on the ASES than did subjects who were not counseled (x = 114.20). Discriminant validity was established for the ASES by examining the relationships between assertiveness and anxiety, self-confidence and locus of control. Anxiety was measured by the Taylor Manifest Anxiety Scale. Self-confidence was measured by the Self-Confidence Scale of the Adjective Check List. Locus of control was measured by Rotter's I-E which is a measure of generalized expectancy for internal versus external control of reinforcement. A discriminant analysis resulted in a significant F value (F(3,54) = 9.56, P [is less than] .001). The variate tests for the three variables revealed that anxiety (F(1,56) = 17.86, p [is less than] .291) did not discriminate between low and high assertive groups (Hollandsworth, Galassi & Gay, 1977).

Convergent and discriminant validity was established by the Campbell-Fiske multitrait-multimethod procedures. Convergent validity was established in terms of ASES' relationship with the constructs of dominance and abasement as measured by a self-report method. Discriminant validity via different assessment methods is only moderate in strength. The inconsistency of discriminant validity findings may be due to the fact that the ASES assesses assertiveness responses in terms of frequency of response instead of verbal content of the situation (Hollandsworth, Galassi & Gay, 1977).

The Scale of Acceptance of Disability

The scale of acceptance of disability (Linkowski, 1971) is a 50-item self report measure of acceptance of disability. It is based on the process of acceptance of loss as a series of value changes. Those who are able to accept their loss are those who: 1) enlarge their scope of values, 2) subordinate their physique, 3) contain disability effects, and 4) transform comparative values to asset values. The AD uses a six-point Likert format (1-6). Respondents are asked to answer by indicating how much they agree or disagree with the statements. The choices for responses range from "I disagree very

much" to "I agree very much." The scores for the AD range from 50 to 300. The mean AD score obtained from rehabilitation clients was 217, with a standard deviation of approximately 37. AD scores falling about 254 or higher are considered high and scores below 180 are considered low.

The validity and reliability for the AD have been investigated. Content validity was determined by expert opinion. Individuals with doctorates in rehabilitation counseling assisted in the process. Split-half reliability for the AD was established by using the odd-even method of correlation from a sample of 46 disabled individuals. Internal consistency reliability was computed to be r = .86 and the application of the Spearman-Brown prophecy formula estimated the full scale reliability to be .93 (Linkowski, 1971).

The AD and the Attitude Toward Disabled Persons Scale (ATDP) were administered to a sample of 101 persons with disabilities. The ATDP, when administered to persons with disabilities, purportedly measures the attitudes that persons with disabilities have toward themselves. The correlation coefficient was .81 and was significant at the p [is less than] .001 level (Linkowski, 1971).

Descriptive Data Form

A descriptive data form was devised for the purposes of this study to gather information from subjects on this demographic variables of age, gender, race, educational level, marital status, residence, type of disability and length of time disabled.

Limitations

Limitations are apparent in the procedures for the study. The selection of subjects was not random. Rather, the sample was based on subjects' availability and willingness to participate in this research. In addition, the instruments used in this study are self-report measures. Self reported responses may be enhanced when compared to in vivo responses. One must use caution in generalizing from self-report to natural behavior (Gorecki, Dickson, Anderson, & Jones, 1981). Further, there are limitations in the administration of the instruments. Rehabilitation personnel administered the instruments to individuals with different types of disabilities. Cassette tapes were made of the instruments and rehabilitation personnel proficient in sign language were used to accommodate the visually and hearing impaired subjects respectively. The instruments were read by the researcher to all mentally retarded subjects. These modifications in the administration of the instruments may have influenced subjects' responses. Finally, the use of reading levels rather than self reported grade levels may have been more appropriate with this population due to the inclusion of mentally retarded subjects.

Results

Results indicated a positive relationship between assertiveness levels and levels of acceptance of disability. In addition, while no difference was found between this sample and the AD norm group, the disabled sample in this study were found to be less assertive than the non-disabled ASES norm group. A relationship was found between educational level and assertiveness. No differences were found between assertiveness and gender, race, metropolitan/non-metropolitan residence, marital status, age or length of time disabled.

Differences were found between acceptance of disability and race, marital status and age and there was a significant relationship between acceptance of disability and educational level. No differences were found in acceptance of disability on the bases of gender, residence or lenght of time disabled.

Type of disability was found to be a significant predictor for both assertiveness and acceptance of disability.

Table 1 presents Pearson product moment correlations used to determine the significance of relationships between ASES scores, AD scores, educational level (EL), age, and length of disability (LD). A p [is less than] .05 level of significance was utilized for the rejection level.

Table 2 presents the multiple regression analysis used to determine significance between the variables of ASES, AD, Age, and length of disability (LD).

Table 3 indicates the analysis of variance determining differences among ASES and AD scores in regard to marital status and type of disability.

A Duncan Multiple range test (Table 4) was used to determine the differences between the groups.

Table 5 presents the t-test values used to determine significance among ASES and AD scores due to gender, race and residence. T-tests were also used to determine differences between the sample and norm groups for the ASES and AD.

Discussion

Assertiveness and Acceptance of Disability

The results of this study indicate that there is a positive relationship between assertive behavior and degree of acceptance of disability among persons with disabilities. These results support the findings of Morgan and Leung (1980). Persons whose feelings are more assertively expressed may move through the rehabilitation counseling process quicker and achieve positive acceptance of their disabilities. They may then refocus their energies toward proactively facing other life concerns. Since a positive relationship exists between assertive behavior and acceptance of disability, it may be possible to increase acceptance of disability levels by providing assertion training and vice versa thus avoiding duplication and increasing economic efficiency.

The sample of individuals in this study was not significantly different from the AD norm group which lends support to the representativeness of this sample. However, there was a significant difference between the study sample of disabled individuals and the ASES norm group of non-disabled person. This result supports the findings of Joiner, Lovett and Hague (1982) that persons with disabilities are less assertive than non-disabled persons. Some persons with disabilities may be less confident of themselves and less able to assert their feelings or stand up for their rights. They may also lack communications skills that may hinder their ability to assert themselves.

Assertiveness and Demographic Variables

Differences were not found in degrees of assertive behavior among persons with disabilities on the bases of gender, race, metropolitan/non-metropolitan residence, marital status or age. A significant relationship was found between educational level and ASES. These results support some, and contradict other findings of Joiner et al. (1982). In their research they found significant differences between male and female assertive behavior scores and between metropolitan/non-metropolitan residents and no significant relationship between ASES and educational level. This study contradicts those findings. Further, Joiner, et al. (1982) found no significant differences between assertive behavior and age, or race. Those findings are supported by the results of this study.

Acceptance of Disability and Demographic Variables

Significant differences were found between AD scores and race, marital status, age and there was a significant relationship between AD and educational level. These results contradict some of the findings of Thomas, Davis, and Hochman (1976) who found no relationship between persons with disabilities acceptance of their disability and their age. Woodrich and Patterson (1983) found an inverse relationship between AD and age. A significant relationship between education level and acceptance of disability found in this study supports similar contentions by Woodrich and Patterson (1983), Thomas, et al. (1976) and Safillos-Rothschild (1970). Correlations indicate an inverse relationship between educational level and the variables of age and length of disability. Significant differences were also found between AD and race and marital status, contradicting the findings of Woodrich and Patterson (1983) and Thomas, et al. (1976). Significant differences were not found in the acceptance of disability on the bases of gender or residence. Gender was found to be a significant variable by Woodrich and Patterson (1983).

While Caucasian persons with disabilities did not have particularly high levels of acceptance of their disabilities, they were found to be more positively accepting of their disabilities than black persons. There are similar prejudicial and stereotypical attitudes toward blacks and persons with disabilities (Kamieniecki, 1985). Being black and disabled may compound negative effects. On the other hand, Jenkins, Amos and Graham (1988) reported finding that black students with disabilities in their study reported being more satisfied with themselves than white students. Unlike Jenkins, Amos and Graham, the subjects in our study were adults. Perhaps levels of acceptance of disability would differ studying younger persons with disabilities. Future research could clarify this point. Persons with disabilities who are divorced were significantly more accepting of their disabilities than never married, married, separated or widowed persons with disabilities. Divorced persons could have more experience with the realities of personal acceptance and adjustment after personal trauma.

Type of Disability and Assertiveness

Type of disability was found to be a significant predictor of assertiveness. These results support contentions made by Joiner et al. (1982) who found no significant differences in ASES scores among disability groups but did note high and low scores between disability groups. The blind group of individuals were found to be significantly more assertive than the other disability groups; substance abusers, deaf, spinal cord injured, cardiac disabled, orthopedically disabled, mentally retarded, and neurologically disabled. Specific educational opportunities and assistance provided by programs for blind persons may enhance their assertion levels. The deaf seem to be exhibiting more assertiveness, as evidenced by the recent Gallaudet University issue and the resultant focus on deaf education and resources. Future research might find increased assertiveness levels in deaf persons as was found in blind persons in the general population due to this current increase in deaf awareness and advocacy. Disabled college students have been found to be more assertive than their peers, (Gambrill, et al., 1986). The same cannot be said for persons with disabilities in general according to the results of this study. Persons with neurologic disabilities were found to be significantly less assertive than the substance abusers as well as the blind persons in the sample. Persons with neurologic disabilities may have complicating lesions in the brain which may affect mood and behavior. There were no differences in degrees of assertive behavior among the other disability groups.

Type of Disability and Acceptance of Disability

The samples of deaf persons and blind persons in this study were significantly more accepting of their disabilities than the cardiac, substance abuse, orthopedic or mentally retarded samples. Specific educational and support systems exist for persons who are deaf or blind which may contribute to their positive acceptance of their disabilities.

The spinal cord injured group was significantly more accepting of their disability than the orthopedic and the mentally retarded groups. Legislation, and economic support has recently focused on the rehabilitation of the spinal cord injured and may be facilitating the acceptance of disability of this group.

The neurologic, cardiac and substance abuser groups were significantly more accepting of their disability than the mentally retarded group. The mentally retarded subjects were high level functioners and many expressed frustration with their condition which may have contributed to their low AD scores.

Additional Findings

Length of time disabled was not found to be a significant variable for assertiveness or for acceptance of disability. These results support findings by Joiner et al., (1982) and contradict Woodrich and Patterson (1983).

The results further indicated that the disabled in this study, are less assertive than the non-disabled norm group. These results support findings by Joiner et al. (1982). In addition the results support the contention by Grambrill, et al. (1986) that while college students with a visible disability were found to be more assertive than their peers this may not be the case in non-university samples.

Conclusion

There are apparent limitations to this study. The results however, support our contention that rehabilitation clients can be identified for assertion training or acceptance of disability facilitation based on need. Future research might further clarify which groups or sub-groups are more amenable to these types of training. Such training has been used effectively to facilitate the rehabilitation counseling process and contribute to successful re-entry into society (Alexy, 1980; Roessler & Cooper, 1978; Farley & Akridge, 1987; Farley & Hinman, 1987; Grimes, 1980; Mishel, 1978; Page, Holland, Rand, Gartin & Dowling, 1981; Morgan & Leung, 1980; Straker, 1978). Beyond re-entry, persons who are more accepting of their disabilities and who are better able to assert themselves may be better able to advocate for their rights and the rights of others. The importance of relevant rehabilitation efforts should take precedence over maintenance services. The support of successful rehabilitation of disabled individuals to productive and proactive lives is sound social and economic policy. [Tabular Data 1 to 4 Omitted]

JAMES G. JOINER is an Associate Professor in the Department of Rehabilitation Counseling at the University of Florida, Gainesville. PAULA S. LOVETT is a private rehabilitation counselor in Gainesville, Fl. LINDA K. GOODWIN is a private consultant in research and evaluation.